Extent of Implantoplasty in the Combined Surgical Therapy of Peri‐Implantitis: A Quasi‐Randomized Clinical Trial

Clinical Implant Dentistry and Related Research · 2026-04-01

OBJECTIVE: The present study aimed to compare the clinical and radiographic performance of full-length implantoplasty (FLIP) versus partial-length implantoplasty (PLIP) for the supracrestal component as part of combined surgical therapy for peri-implantitis with a ≥ 3 mm depth at the intrabony component. MATERIALS AND METHODS: A single-center, prospective, randomized, controlled, two-arm comparative study was conducted to evaluate the extent of implantoplasty-limited to the supracrestal component (PLIP) or extending to both supracrestal and intrabony components (FLIP)-in the combined surgical management of peri-implantitis. Clinical and radiographic outcomes were assessed 1 year after surgery. Disease resolution was defined using a composite of clinical and radiographic criteria, although sample size was calculated for pocket depth reduction. Generalized estimating equations were applied to calculate unadjusted and adjusted odds ratios. RESULTS: = 40) completed the study. All evaluated clinical parameters in both groups showed statistically significant changes over the study period. A significant intergroup difference was observed for modified sulcus bleeding index (mSBI), favoring FLIP (p = 0.003). Marginal recession (MR) was significantly greater in the FLIP group compared with the PLIP group (p = 0.006) and was more pronounced in the posterior mandible (p = 0.002). No other clinical parameters differed significantly between groups. Regarding marginal bone level (MBL) gain, FLIP demonstrated a statistically significant advantage over PLIP in the adjusted model (p = 0.009). For the remaining radiographic variables, significant changes were observed at the 1-year follow-up assessment, but no significant intergroup differences were detected. Overall disease resolution was achieved in 77.5% of cases. The adjusted model showed no statistically significant difference between the tested groups (OR = 14; p = 0.13). Smoking was consistently associated with less favorable clinical and radiographic outcomes. No major postoperative complications were reported. CONCLUSION: Combined surgical therapy for peri-implantitis, including implantoplasty and regeneration of the intrabony component, is effective in arresting disease progression and restoring peri-implant health. Extending implantoplasty to the contained intrabony compartment appears to provide additional clinical and radiographic benefits. However, this advantage comes at the expense of increased mucosal recession, highlighting the need for careful case selection and patient counseling.

Extent of Implantoplasty in the Combined Surgical Therapy of Peri-Implantitis: A Quasi-Randomized Clinical Trial.

Open Access CRIS of the University of Bern · 2026-04-01

Objective The present study aimed to compare the clinical and radiographic performance of full-length implantoplasty (FLIP) versus partial-length implantoplasty (PLIP) for the supracrestal component as part of combined surgical therapy for peri-implantitis with a ≥ 3 mm depth at the intrabony component.Materials And Methods A single-center, prospective, randomized, controlled, two-arm comparative study was conducted to evaluate the extent of implantoplasty-limited to the supracrestal component (PLIP) or extending to both supracrestal and intrabony components (FLIP)-in the combined surgical management of peri-implantitis. Clinical and radiographic outcomes were assessed 1 year after surgery. Disease resolution was defined using a composite of clinical and radiographic criteria, although sample size was calculated for pocket depth reduction. Generalized estimating equations were applied to calculate unadjusted and adjusted odds ratios.Results A total of 33 patients (Nimplants = 40) completed the study. All evaluated clinical parameters in both groups showed statistically significant changes over the study period. A significant intergroup difference was observed for modified sulcus bleeding index (mSBI), favoring FLIP (p = 0.003). Marginal recession (MR) was significantly greater in the FLIP group compared with the PLIP group (p = 0.006) and was more pronounced in the posterior mandible (p = 0.002). No other clinical parameters differed significantly between groups. Regarding marginal bone level (MBL) gain, FLIP demonstrated a statistically significant advantage over PLIP in the adjusted model (p = 0.009). For the remaining radiographic variables, significant changes were observed at the 1-year follow-up assessment, but no significant intergroup differences were detected. Overall disease resolution was achieved in 77.5% of cases. The adjusted model showed no statistically significant difference between the tested groups (OR = 14; p = 0.13). Smoking was consistently associated with less favorable clinical and radiographic outcomes. No major postoperative complications were reported.Conclusion Combined surgical therapy for peri-implantitis, including implantoplasty and regeneration of the intrabony component, is effective in arresting disease progression and restoring peri-implant health. Extending implantoplasty to the contained intrabony compartment appears to provide additional clinical and radiographic benefits. However, this advantage comes at the expense of increased mucosal recession, highlighting the need for careful case selection and patient counseling.

Surgical‐ and implant‐related factors and onset/progression of peri‐implant diseases: An AO/AAP systematic review

Journal of Periodontology · 2025-06-01 · 9 citations

BACKGROUND: The objective of this systematic review was to shed light on the importance of surgical- and implant-related factors on the onset/progression of peri-implant diseases. This systematic review provides an evidence-based overview on the prevention of peri-implant diseases for the Academy of Osseointegration (AO)/American Academy of Periodontology (AAP) Consensus Conference held in August 14-16, 2024 in Oakbrook, IL, USA. METHODS: Systematic screening of electronic sources was performed to identify clinical studies reporting on the impact of surgical- and implant-related factors on peri-implant diseases. To fulfil the inclusion criteria, a composite clinical and radiographic case definition for peri-implant mucositis and/or peri-implantitis had to be reported. Prevalence or incidence (%) of peri-implant diseases was extracted at patient- and implant-level. Moreover, odds/hazard ratios were collected to explore potential associations. RESULTS: = 4072). Given the high heterogeneity across the studies, only qualitative assessment was performed. Clinical evidence proved that surgical-related factors, in particular inadequate implant position and, to a lower extent, implants placed in regenerated bone, are more prone to exhibit peri-implantitis, but not peri-implant mucositis. With regards to specific implant-related factors, insufficient evidence, did not allow for exploring specific associations with the onset/progression of peri-implant diseases. However, it was found that a short distance from the prosthetic margin to crestal bone during implant placement may be a predisposing factor for peri-implantitis. CONCLUSION: Clinical evidence linking surgical- and implant-related factors and peri-implant diseases is sparsely reported in the literature. Nevertheless, it appears that implant malposition plays a crucial role on the onset/progression of peri-implantitis. PLAIN LANGUAGE SUMMARY: The objective of this systematic review was to shed light on the importance of surgical-and implant-related factors on the onset/progression of peri-implant diseases. Overall, 33 articles were included in the qualitative synthesis. Of these, 21 explored surgical-related factors. Given the high heterogeneity across the studies, only qualitative assessment was performed. Clinical evidence proved that surgical-related factors, in particular inadequate implant position and, to a lower extent, implants placed in regenerated bone, are more prone to exhibit peri-implantitis, but not peri-implant mucositis. With regards to specific implant-related factors, insufficient evidence, did not allow for exploring specific associations with the onset/progression of peri-implant diseases. However, it was found that a short distance from the prosthetic margin to crestal bone during implant placement may be a predisposing factor for peri-implantitis. All in all, implant malposition plays a crucial role on the onset/progression of peri-implantitis.

Recombinant human platelet-derived growth factor-BB-mediated reconstructive therapy of advanced peri-implantitis bone defects: A case series.

PubMed · 2025-03-06

BACKGROUND: The treatment of advanced peri-implantitis-related bone defects is often associated with ineffective efforts to halt disease progression. The objective of this case series was to evaluate the performance of reconstructive therapy for the management of advanced peri-implantitis using recombinant human platelet-derived growth factor-BB as an adjunctive biological agent. MATERIALS AND METHODS: A prospective case series study on advanced intrabony peri-implantitis bone defects (≥ 50% bone loss) was performed. Clinical and radiographic variables were collected at baseline (after non-surgical therapy) and 12 months after surgical treatment. Implant surface decontamination of the intrabony component was carried out using titanium brushes and the electrolytic method. Before grafting, recombinant human platelet-derived growth factor-BB was applied on the implant surface. A mixture of mineralised allograft and xenograft hydrated with recombinant human platelet-derived growth factor-BB and covered by a collagen barrier membrane was used for reconstructive therapy. Disease resolution was defined as an absence of bleeding on probing, pocket depth 6 mm and no radiographic evidence of progressive bone loss. Descriptive statistics were performed to assess the effect of treatment on the clinical and radiographic variables. RESULTS: A total of 10 patients exhibiting 13 advanced peri-implantitis-related bone defects were included. Implant survival at the 1-year follow-up was 100%. No major complications occurred during the early healing phase. All the clinical parameters, with the exception of keratinised mucosa, and radiographic parameters yielded statistical significance. In particular, mean pocket depth decreased by 4.5 mm and the mean Sulcus Bleeding Index was reduced by 1.8. Radiographic intrabony defects displayed a significantly narrower, shallower and less angled configuration at the 1-year follow-up. The disease resolution rate at implant level was 61.5%. CONCLUSION: The surgical reconstructive strategy involving the use of recombinant human platelet-derived growth factor-BB proved to be safe and effective for treating advanced peri-implantitis-related bone defects.

Role of Local Factors on the Occurrence of Peri‐Implantitis: A Cross‐Sectional Analysis

Clinical Oral Implants Research · 2025-09-08 · 5 citations

OBJECTIVE: A cross-sectional study was made to evaluate the role of local factors, including surgical, implant, and prosthesis-related parameters, in the presence of peri-implantitis. METHODS: Consecutive partially edentulous patients with ≥ 1 implant presenting peri-implantitis were included. Clinical and radiographic data were collected to characterize local factors. Overall, 28 site-specific variables were analyzed for peri-implantitis and non-peri-implantitis implants. Simple and multiple logistic regression analyses were performed to explore potential associations. The diagnostic accuracy of those variables that demonstrated statistical significance in the multiple logistic regression analysis was further tested. RESULTS: In total, 100 patients with 452 implants met the inclusion criteria. Of these, 227 implants (50.2%) were diagnosed with peri-implantitis, while 225 (49.8%) did not present peri-implantitis. The multiple logistic regression analysis demonstrated statistical significance for the following factors: (1) medial implant position within the prosthesis (OR = 3.9) was more prone to develop peri-implantitis; (2) internal Morse taper implant connection was the least likely to develop peri-implantitis (OR = 0.43); (3) mesio-distally centered implants were less prone to exhibit peri-implantitis (OR = 0.46); (4) bucco-lingual centered implants were less prone to exhibit peri-implantitis (OR = 0.29); (5) implants positioned inside (≥ 2 mm) the bony housing were less prone to exhibit peri-implantitis (OR = 0.13); and (6) implants tilted 10°-30° (OR = 5.84) and ≥ 30° (OR = 7.43) were more prone to exhibit peri-implantitis. Moreover, a prediction model based on the aforementioned factors yielded a high level of accuracy. CONCLUSIONS: Implant malpositioning is a critical factor associated with peri-implantitis.

Clinical and Histologic Evidence Documenting the Long-Term Success of Regenerative Therapy Using an Allograft-Biologic Combination

The International Journal of Periodontics & Restorative Dentistry · 2025-09-01

This retrospective case report documents the successful use of a mineralized allograft hydrated by a combination of recombinant human platelet derived growth factor-BB and enamel matrix derivative to regenerate the buccal furcations of two adjacent maxillary molars. Twelve years later, despite the complete fill with bone in both furcations, the second molar developed a resorptive lesion near the furcation area requiring its removal. The surgical procedure to replace it with a dental implant enabled visual inspection of the furcations on both teeth and histologic evaluation of the second molar's complete furcation fill. The findings from this case present the potential to regenerate a stable new attachment apparatus. The histologic findings further elucidate both the long term fate of this graft-biologic combination which did not completely turnover to host bone as well as the contribution that it may play in guided tissue regenerative therapy.

Efficacy of Decontamination Methods for Biofilm Removal from Dental Implant Surfaces and Reosseointegration: An AAP/AO Systematic Review on Peri-implant Diseases and Conditions.

PubMed · 2025-06-06 · 1 citations

PURPOSE: To evaluate the nonclinical evidence concerning the efficacy of different decontamination methods in facilitating reosseointegration, eliminating biofilm from implant surfaces, and their potential to induce adverse surface modifications and release of material remnants. MATERIALS AND METHODS: Systematic electronic and manual searches were conducted to identify publications involving animal or human block biopsies, ex vivo/in situ studies, and in vitro studies. Mechanical, chemical, and electrolytic methods for implant decontamination were presented in a descriptive analysis. RESULTS: A total of 121 studies were included, namely 46 involving animal/human biopsies, 39 ex vivo/in situ experiments, and 36 in vitro investigations. No modality demonstrated significant superiority in terms of reosseointegration outcomes. Ex vivo, in situ, and in vitro studies reported that greater biofilm removal from implant surfaces occurred with polyetheretherketone (PEEK) ultrasonic tips, air-powder abrasive (APA), erbium: yttrium-aluminum-garnet (Er:YAG) laser, and electrolytic cleaning. Minimal surface alterations were noted with soaked cotton pellets, APA, specific settings of Er:YAG laser, erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser, electrolytic treatment, and cold atmospheric plasma. Titanium or stainless steel curettes, ultrasonic tips, titanium brushes, and implantoplasty induced significant surface alterations and peak flattening of implant threads. Plastic and carbon curettes as well as PEEK ultrasonic tips and APA left material remnants. CONCLUSIONS: Implant reosseointegration is possible following appropriate surface decontamination. Application of Er:YAG laser, electrolytic cleaning, and APA stand out as the methods that most closely embody the ideal characteristics of an effective decontamination protocol.

Treatment of External Cervical Resorption via Surgical Crown Lengthening and Concomitant Placement of a Resin Modified Glass Ionomer Restoration: A Case Series a 1-4 Year Follow Up

The International Journal of Periodontics & Restorative Dentistry · 2025-03-01 · 1 citations

External cervical resorption is a disease entity with an idiopathic etiology by which osteoclastic invasion cavitates teeth near the cemento-enamel junction. The lesion, if left untreated, has the potential to progress and compromise tooth maintainability. Treatment of these lesions requires access, often surgical, removal of the affected tissue, and placement of a restorative material. This case series documents 10 external cervical resorption lesions that were treated by surgical crown lengthening with concurrent placement of a resin modified glass ionomer restoration and followed for a period ranging from July 2020 to July 2024. This case series offers evidence that external cervical resorption can be treated with a high expectancty of tooth survival. Longer term follow-up will be needed to see if this treatment remains stable and predictable.

Surgical Reconstructive Therapy for the Management of Peri-implantitis: An AAP/AO Systematic Review and Network Meta-analysis.

PubMed · 2025-06-06 · 3 citations

PURPOSE: Reports on the occurrence of peri-implant diseases date back nearly two decades. Despite the attempts taken toward the management of this disease, the literature still lacks a common remedy for predictable treatment. This best evidence consensus review was conducted in preparation for the joint consensus between the American Academy of Periodontology (AAP) and the Academy of Osseointegration (AO) to systematically analyze the clinical research in the field of surgical reconstructive therapy for peri-implantitis. MATERIALS AND METHODS: A detailed systematic search was conducted to identify eligible clinical research reporting the outcomes of surgical reconstructive therapy for periimplantitis. The retrieved nonrandomized studies were analyzed descriptively, while the data from randomized control trials (RCTs) were fit to a series of mixed models that analyzed the individual components of the study arms and rendered treatments for the outcomes of probing pocket depth (PPD) reduction, radiographic marginal bone level (Rx MBL) gain, reduction in bleeding on probing (BoP) and suppuration (SUP), as well as mucosal recession (MREC). RESULTS: A total of 18 reports on RCTs were eligible for quantitative assessment (635 patients, 687 implants). The results indicated that surgical reconstructive approaches for peri-implantitis (based on 319 patients and 345 implants), when compared to a nonreconstructive treatment modality (ie, open flap debridement alone based on 316 patients and 342 implants), was effective in reducing PPD, minimizing MREC, as well as increasing Rx MBL gain. However, there was no additional benefit from employing a reconstructive approach regarding the outcomes of BoP and SUP reduction. Several other baseline covariates such as site (initial PPD, MBL, and BoP) and systemic factors (eg, smoking) were also found to significantly impact the therapeutic outcomes. Mechanical decontamination methods as well as individual components of the augmentation approach were also found to significantly affect the outcomes. CONCLUSIONS: Within the limitations of this study, it was demonstrated that the surgical treatment of infrabony peri-implantitis defects can lead to PPD reduction, MREC reduction, and Rx MBL gain and was found to be superior to nonreconstructive treatment. However, there were no significant differences between the two modalities of therapy for the outcomes of BoP and SUP. Reconstructive therapy may provide a suitable approach for managing peri-implantitis-related infrabony defects.

The influence of prosthetic designs on peri‐implant bone loss: An AO/AAP systematic review and meta‐analysis

Journal of Periodontology · 2025-06-01 · 27 citations

BACKGROUND: Implant prosthetic design significantly impacts peri-implant health. This systematic review and meta-analysis explored emerging concepts in prosthetic considerations, appraising the level of evidence and clinical significance of these suprastructures on peri-implant marginal bone loss (MBL). METHODS: An electronic search of three databases and a manual search of peer-reviewed journals for relevant articles published in English between January 1980 and December 2023 were performed. Eligible studies featured dental implants restored within ≥12 months, with ≥10 implants in each group. Inverse variance meta-analyses were performed to compare various prosthetic factors and their impact on MBL and the risk of peri-implantitis. RESULTS: Screw-retained versus cement-retained prostheses demonstrated no significant difference in MBL (six articles, p = 0.51). Nonsplinted implants exhibited lower MBL compared to their splinted counterparts (eight articles, p = 0.04). Platform-switched abutments were correlated with reduced MBL compared to platform-matched ones (20 articles, p < 0.0001). Internal connections, particularly conical ones, displayed less MBL than external connections (20 articles, p < 0.0001). The crown-to-implant ratio did not significantly affect MBL (five articles, p = 0.32). Abutment heights ≥2 mm are associated with less MBL than heights <2 mm (12 articles, p < 0.0001). Implementing a one abutment-one time protocol resulted in less MBL than repeated abutment disconnections (10 articles, p < 0.0001). Emergence angles <30° and a concave/straight profile led to lower peri-implantitis risk (two articles each; p = 0.05 and p = 0.03, respectively). CONCLUSIONS: Nonsplinted implants, platform-switched abutments, abutment heights ≥2 mm, and a one abutment-one time approach yielded significant reductions in MBL compared to their counterparts. Furthermore, emergence angles <30° and a concave/straight emergence profile were linked to decreased peri-implantitis risk. Meanwhile, factors such as screw-retained versus cement-retained prostheses and crown-to-implant ratio yielded no significant difference in MBL. PLAIN LANGUAGE SUMMARY: The design of implant-supported tooth replicas plays a key role in keeping the surrounding gums and bone healthy. This study reviewed research from 1980 to 2023 to examine how different design features of these restorations impact oral tissue health. A total of 93 studies were included, focusing on patients aged 18 years and older, with at least 10 patients in each group. The findings showed that individual tooth replicas (rather than splinted ones) led to better gum health. A horizontal offset at the implant-replica junction helped reduce bone loss. Implants with internal connections (inside the implant body) performed better than those with external connections. Tooth replicas with narrow contours at the implant junction were more beneficial than convex shapes. Additionally, using abutments taller than 2 mm and minimizing the number of times an abutment is removed during fabrication helped preserve surrounding tissues. These findings highlight how careful implant design can improve long-term oral health, reducing complications and maintaining stability around dental implants.